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Taking back-to-school to heart

September 16, 2008

With a new environment, new friends and new activities, the first day of school is a big step in the lives of young school-age children and one that requires all their cognitive, motor and social-emotional skills. This challenge is even greater for those born with a congenital heart malformation and who underwent open-heart surgery soon after birth. In her latest study, Dr. Annette Majnemer, from the Research Institute of The Montreal Children's Hospital at the MUHC, has assessed the developmental difficulties in these children and provided keys for possible prevention. Her article was recently published in the Journal of Pediatrics.

"Our results show that these young 'survivors' of heart surgery at birth are more likely to have difficulties in school," Dr. Majnemer explained. "These difficulties can be linked to their learning abilities, as the average IQ of the surveyed patients was average or low, with 22% having an IQ below 80. Also, 27% of these children experience behaviour problems that often lead to challenges in social development and, later, with lower self-esteem."

The patients involved in this study were tested at birth and early infancy, at 18 months and at five years. A careful assessment before surgery revealed nervous system anomalies in more than 50% of the newborns who were to have open-heart surgery soon after birth, as well as in over a third of the infants who were to have it a bit later in life. It is therefore very probable that the heart malformation is associated with a lack of adequate oxygen supply to the brain early in life, or even before birth, which hampers the child's development independent of the surgery. This would also explain the researchers' clear finding that the older the child at the time of the operation, the lower his or her IQ.

"We need to understand the mechanisms that cause this delay in cognitive development as well as other developmental domains in children born with a congenital heart malformation," Dr. Majnemer stated. "This will give us a case to promote early intervention and therefore help prevent or minimize developmental delays in a number of children. It will also give families access to better quality information to help them make informed choices about services needed and enable them to better monitor their children."

Monitoring the global development of children who have undergone this surgical procedure has not yet been established as standard health practice in Canada. However, a developmental surveillance program is in place at the Montreal Children's Hospital for newborns diagnosed there. "We hope that this study will be a first step towards generally implementing developmental screening and timely referral to rehabilitation and educational specialists if needed, as this is a common request from the families of patients," Dr. Majnemer recommended.

McGill University Health Centre